Document 410022

Common Compensatory Pattern –
Treatment in a Busy Practice
David R. Boesler, D.O.
Chair, Department of
Neuromusculoskeletal Medicine
Nova Southeastern University
What is the Common
Compensatory Pattern?
An alternating pattern of fascial
preferences
Fascia is affected by a person’s structural,
functional, and emotional stresses
 Fascia responds to stresses, and absorbs
and distributes forces placed upon it
 Fascial strains disrupt the normal
homeostatic mechanisms in the body
 Alternating fascial patterns in the body can
be a homeostatic response to stressors
when an “ideal” cannot be met

Common
Can be found in large portion of the
population
 Seen in both symptomatic and
asymptomatic people

Compensatory
“ The fascia is the place to look for the
cause of disease and the place to
consult and begin the action of
remedies in all diseases”
Common Compensatory
Pattern (CCP)
An efficient way to structurally evaluate
and treat your patient
A blueprint to follow in the treatment of
the axial skeleton
A pattern of treatment utilizing the four
major diaphragms of the body
Four Major Transverse
Diaphragms of the Body
 Pelvic
diaphragm
 Thoracoabdominal (respiratory)
diaphragm
 Cervicothoracic (thoracic inlet)
diaphragm
 Tentorium cerebelli
Respiratory-Circulatory Model
Addresses both the respiratory and
circulatory system in the homeostatic
response
Encourages proper oxygenation to the
cells, tissues, and organs; and proper
removal of waste products from the
tissues, cells, organs
Respiratory-Circulatory Model
Concerned with delivering oxygen and
nutients to the tissues and removal of
cellular waste products
This treatment plan will encourage
proper healing from any source,
whether structural or visceral
dysfunction
D.O. = Deliver Oxygen
From Kuchera and Kuchera 1994
OA
Compensated Patterns:
•L/R/L/R
•R/L/R/L
CT
TL
LS
OA
Uncompensated Patterns
CT
TL
LS
The transitional areas of the spine are
commonly the areas that can be subject
to the greatest trauma.
where the head meets the neck
 where the neck meets the thorax
 where the thorax meets the lumbar spine
 where the lumbar spine meets the pelvis

Restriction in any of these transitional
areas can cause major alterations in the
function of the surrounding structures,
and can directly or indirectly affect the
health of the body
History of CCP
J. Gordon Zink, D.O., F.A.A.O.
Late 1970’s
 Correlated data from patients
 Published first article on CCP in 1979

Zink found these alternating patterns in
patients who were “healthy” individuals.
Patients who did not have an ideal
fascial pattern, or no fascial preferences
were considered non-compensated.
These non-compensated patterns were
usually traumatic in origin, or seen in
chronic illnesses.
Zink found that if a patient’s fascia fell
into a certain pattern of compensation,
they tolerated stress and disease better
than those who did not.
These patients also better tolerated any
somatic dysfunctions they had.
These patients also were found to
recover quicker and respond to medical
care more predictably.
The Common Pattern
Lumbosacral area – rotated right
Thoracolumbar area – rotated left
Cervicothoracic area – rotated right
Upper cervical area – rotated left
From Kuchera and Kuchera 1994
CCP
1. Innominate rotation
2. Sacrum
3. Lumbosacral area
4. Thoracolumbar junction
5. Lower left ribs
6. Upper left ribs
7. Upper right thoracic vertebrae
8. Cervicothoracic junction
9. Upper cervical area (including OA)
The transitional areas of the spine are
commonly the areas that can be subject
to the greatest trauma.
where the head meets the neck
 where the neck meets the thorax
 where the thorax meets the lumbar spine
 where the lumbar spine meets the pelvis

From Kuchera and Kuchera 1994
What will addressing this CCP
do?
Relieve myofascial torsions in the body
Affect the autonomic nervous system
Improve diaphragmatic function
Improve venous/lymphatic flow
It’s time to get your
Osteopathic Hands on!
CCP
1. Innominate rotation
2. Sacrum
3. Lumbosacral area
4. Thoracolumbar junction
5. Lower left ribs
6. Upper left ribs
7. Upper right thoracic vertebrae
8. Cervicothoracic junction
9. Upper cervical area (including OA)